Needed: Course Registration Form on My Wordpress Website

Im looking for a Wordpress freelancer who can complete my job in a timely fashion, though I dont know how fast that can be. I want to be reasonable, but I do need it as soon as possible.

I need help with
1. Creating a registration form for when a person registers for the course on my website, AND
2. The proper fields (first and last name, along with any ID) to show on the completion certificate once they successfully complete it. Right now, just the username shows.

On the Registration form, I want the following fields to have to be filled in:

- First Name
- Last Name
- Email
- City of Residence
- State
- ZIP

- Drop Down Menu - Parent, School Staff, Childcare Provider, Homeschooling Parent, Individual, Other Institutional Affiliation ____________________
o Under Parent
o Drop-Down - School-age, Daycare/Preschool
- Under School-age
o School1 Name
o School Code
o District Name
o City, State & ZIP of School
o Child(ren)s First initial and Last Name
o Option to enter a 2nd, 3rd school name
- Under Daycare
o Name of Daycare/Preschool
o School Code
o City, State & ZIP of Daycare/Preschool
o Childrens First Initial and Last Name
o Under School Staff
o School Name
o School Code
o District Name
o City, State & ZIP of School
o Position (Drop down menu) - Teacher, Student Support, Principal, School-Level Administrator, District-Level Administrator)
o Under Childcare Provider
o Name of Daycare/Preschool
o School Code / MOP ID (For CEUs)
o City, State & ZIP of Daycare/Preschool
o Position (Drop down menu) - Teacher, Childcare, Administrator, Other _____________
o Under Homeschooling Parent
o Number of Children
o Ages of Children (separated by commas)
o Please check
- My family is / I am homeschooling my child(ren) unassisted
- My family / I homeschool my, and other peoples children unassisted
- I am homeschooling my children in partnership with someone else who homeschools
- I am part of a homeschool cooperative/association
o Name of Homeschooling Cooperative/Association
o Under Individual
o Age
o I am taking this course for (Drop-down menu)
- Parent Preparation
- Research
- Other ________________________
o Under Other Institutional Affiliation
o Institution (Fill-in)
o MOP ID / Institution Code (For CEUs)
o Affiliation with Institution (Fill-in)
About the recuiter
Member since May 20, 2018
Ima Senthil Kum
from Tamil Nadu, India

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